Abstract
Objectives
Strict exclusion of gluten is the cornerstone of celiac disease (CD) management; nevertheless, maintaining dietary adherence remains challenging. The COVID-19 pandemic may have influenced dietary adherence in children with CD. This study aimed to investigate the association between the COVID-19 pandemic and gluten-free diet (GFD) adherence and anthropometric measurements.
Methods
This retrospective longitudinal cohort study with a cross-sectional survey component included 81 pediatric patients with CD (67.9% female; mean age 14.9 ± 3.4 years) who had been following a GFD for at least one year before the pandemic. Demographic, clinical, laboratory, and anthropometric data from the pre-pandemic, restriction, and post-pandemic periods were obtained from medical records. Dietary adherence was assessed via a structured telephone questionnaire. Participants reporting either complete avoidance of gluten or fewer than six inadvertent gluten exposures annually were categorized as self-reported adherent. Serological adherence was defined by a negative tTG-IgA result.
Results
At the beginning of the pandemic in March 2020, the mean duration of GFD was 3.9 ± 2.4 years. At the time of the survey, self-reported adherence was 67.9% (55/81), whereas serological adherence was 77.1% (54/70). During the pandemic, 49.4% of participants reported no change in dietary adherence, 33.3% reported increased adherence, and 17.3% reported decreased adherence. Serological adherence differed significantly across the three longitudinal assessment periods (Cochran's Q = 31.818,
p
p
p
= 0.227). Serological adherence was associated with home-cooking and selected family and socioeconomic factors. Most participants (87.7%) reported difficulty accessing gluten-free products, mainly due to high cost and limited variety. No significant differences were observed in anthropometric measurements across the study periods.
Conclusion
Serological adherence was significantly higher during both the COVID-19 restriction and post-pandemic periods than during the pre-pandemic period, while no significant changes in anthropometric measurements were observed.